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Safeguarding health care: it's a matter of life and death

29-11-2011 Interview

Violence against health care personnel, patients and structures prevents millions of people from receiving life-saving health care. The ICRC is submitting a resolution to this week's 31st International Conference of the Red Cross and Red Crescent aimed at addressing this humanitarian challenge. The resolution aims to safeguard the delivery of health care in armed conflict and other emergencies. Paul-Henri Arni, an experienced ICRC manager who leads the organization's efforts to address the issue, describes what's at stake and how the ICRC hopes to achieve its goal over the next few years.

What does the prevention of the delivery of health care due to illegal and sometimes violent acts concretely mean for people? How many does this affect?

The first thing to note is that in armed conflict, the ability to meet medical needs goes down just as these needs skyrocket. This is not only the result of attacks against health workers, but also against ambulances, clinics, and even patients. In addition, threats to safety prevent people from reaching health centres and disrupt supplies.

Then there is the knock-on effect that one major incident can have. Once health-care workers or infrastructure are hit, countless people are deprived of treatment. When a bomb attack killed over a dozen medical students at their graduation ceremony in Somalia in 2009, it not only tragically eliminated one of the very few groups of medical graduates the country has seen in 20 years, but also meant that tens of thousands of medical consultations per year will never take place as a result of this single attack.

This issue lies at the core of our work. We simply cannot accept that patients get shot in their beds or arrested in health centres, that doctors go missing, that ambulances are targeted on their way to hospitals and that children die because vaccination campaigns can no longer take place.

You recently launched a report called 'Health care in danger: making the case'. Could you give some concrete examples from the report?

There are many examples, the most recent of which took place in the Middle East. I think a key finding of our report is that tens of thousands could be spared if the delivery of health care were more widely respected. Concretely, people die in large numbers not because they are direct victims of a roadside bomb or a shooting. They die because the ambulance does not get there in time, because health-care personnel are prevented from doing their work, because hospitals and patients are direct targets of attacks or simply because the environment is too dangerous for effective health care to be delivered.

I recently travelled to Afghanistan where our health staff constantly see mothers coming in with dead or dying children who are sick with preventable diseases. But parents wait until the last minute to actually travel to the hospital, because travelling in Afghanistan is simply very dangerous, with many checkpoints to cross. Many arrive too late. Ultimately, this is not about the health care community. This is about the people who require health care and are prevented from getting it. This is our true concern. It affects large numbers of people.

What should be done and how is the ICRC planning to address the issue?

Enabling secure access to health care in conflicts and other emergencies goes back to the very heart of the Red Cross / Red Crescent identity. Adopting the resolution on respecting and protecting health care in armed conflict and other emergencies will be a strong signal from States and the Movement to tackle one of the largest – yet least recognized – humanitarian problems. Reactions to early drafts have been encouraging. We do hope that all participants at the 31st International Conference of the Red Cross and Red Crescent will adopt this resolution as a first important step.

The ICRC, National Societies and even the entire health-care community alone cannot address this challenge. It is imperative that States, their armed forces but also non-state armed groups get engaged. Those who are responsible for the threats to health care need to come to the table.

How can the international community contribute?

Respect for existing laws needs to be strengthened, armed forces need to be trained on appropriate behaviour at checkpoints, rebel groups need to respect patients and not interrupt hospital work to interrogate someone who really is not fit for an interrogation, and so on. It is a large and complex issue, which is precisely why we say that it needs to be addressed by many stakeholders.

It is with this in mind that the ICRC, over the next four years, will bring together health staff, military personnel, states, policymakers and humanitarian actors, to identify necessary measures to end violence against health care. Together we will examine the role of military practice, the rights and responsibilities of health care personnel, the physical protection of health centres, and the role of National Societies to mitigate violence against health care and develop legal instruments to prevent and repress crimes against patients and health professionals.

Through expert consultations between the 31st and 32nd International Conferences of the Red Cross and Red Crescent (in 2011 and 2015, respectively), we will identify practical solutions to better protect health care during armed conflict and other emergencies. The outcomes of these events, together with concrete activities in the field based on improved data collection on incidents and abuses committed against health care services and wounded and sick people, will strengthen the operational response of the ICRC and Red Cross and Red Crescent National Societies.

This project will be implemented through these two tracks – a diplomatic one and an operational one. We need to engage States and armed groups so that they live up to their responsibilities. But we also need to do more and better in the field, and reinforce our operational response. The ultimate goal of this double-track strategy is to safeguard the delivery of health care on the ground and thereby make a difference for victims. It's really a matter of life and death.


Photos

Paul-Henri Arni 

Paul-Henri Arni
© ICRC

Fallujah, Iraq, 13 September 2004. This ambulance was destroyed in an attack, killing the driver, two nurses and the five wounded people it was transporting to hospital. 

Fallujah, Iraq, 13 September 2004. This ambulance was destroyed in an attack, killing the driver, two nurses and the five wounded people it was transporting to hospital.
© AFP PHOTO / Fares Dlimi

Mizdah, Libya. Mizdah hospital was hit with shrapnel wounding several patients who were in their beds. 

Mizdah, Libya. Mizdah hospital was hit with shrapnel wounding several patients who were in their beds.
© Christopher Morris/VII

The Health Care in Danger exhibition at the 31st International Conference of the Red Cross and Red Crescent. The exhibit shows on one side how a cholera dispensary might look when health care is safeguarded. As a mirror effect, the opposite side illustrates the disastrous consequences when medical facilities are not respected nor protected during armed conflict. 

The Health Care in Danger exhibition at the 31st International Conference of the Red Cross and Red Crescent. The exhibit shows on one side how a cholera dispensary might look when health care is safeguarded. As a mirror effect, the opposite side illustrates the disastrous consequences when medical facilities are not respected nor protected during armed conflict.
© ICRC / T. Gassmann / cer-e-00846

Geneva, Switzerland. A plenary session of the 31st International Conference of the Red Cross and Red Crescent, which will consider an ICRC resolution addressing the vast humanitarian challenge of violence against health-care workers, patients and structures. 

Geneva, Switzerland. A plenary session of the 31st International Conference of the Red Cross and Red Crescent, which will consider an ICRC resolution addressing the vast humanitarian challenge of violence against health-care workers, patients and structures.
© ICRC / T. Gassmann / cer-e-00849